Apply the concepts of epidemiology and nursing research to a communicable disease
Concepts in Community and Public Health
Epidemiology is an important concept in community and public health. It is a field that focuses on the study of diseases and how they are distributed among different population groups. Epidemiology assist community and public health care providers to understand the prevalence of a disease, what causes the disease to be prevalent in one group as compared to another, and how best to deal with the disease by understanding the epidemiologic triangle. As such, it is an assistive field in community and public health especially in combating various preventable diseases. This paper will focus on the epidemiology of TB, where different aspects surrounding the infectious disease will be discussed.
Tuberculosis (TB)
Tuberculosis, popularly known by its acronym TB, is a disease caused by bacteria, which was discovered in 1882, by Dr. Robert Koch when he discovered the causative agent, Mycobacterium Tuberculosis. The disease is hailed as the leading cause of death globally from a single infection. It is also regarded as the leading cause of death amongst people with Human Immuno-deficiency Virus (MacNeil et al., 2019). The statistics have prompted various agencies including the UN in their sustainable development goals and the WHO to put in place strategies and timelines to reduce the number of TB cases globally. Other than those with HIV, TB is known to be more prevalent in infants, older adults and people with weak immunity. The disease is also more prevalent in congested areas, in areas with poor air quality and people with poor nutrition.
As earlier indicated, the disease is caused by a bacterium called mycobacterium tuberculosis (Khan, 2017). The disease is airborne and is spread by inhaling droplets containing the bacteria, for example, from coughs or sneezing. With regards to symptoms, TB can be categorized into two, i.e., active and inactive Tb. It is estimated that over two billion people globally have inactive TB in their bodies (MacNeil et al., 2019). Inactive TB, also known as latent TB is mainly asymptomatic and cannot be spread from person to person. However, it can turn to active TB, thus treatment of persons with latent TB is appropriate to prevent the development of the disease to active TB where it can spread to others and is accompanied by negative health outcomes. In active TB, the symptoms include prolonged coughing (lasting more than three weeks), coughing blood, chest pains when breathing or coughing, wheezing sounds when breathing, fever and fatigue, and sudden loss of weight. One of the complications of TB is that it can further spread into other organs including the brain, kidneys, spine, which will be accompanied by other symptoms, for example, presence of blood in the urine in case of TB infection of the kidneys (Cudahy & Shenoi, 2016).
Upon witnessing the above-listed symptoms, it is advisable to seek medical help where screening can be conducted to ascertain the presence of infection and prompt therapy to prevent further spread of the infection and to facilitate quick recovery of the patient. The CDC advises that people who are considered at higher risk of latent TB, get screened so that they can be put into therapy before the disease develops into active TB, in case the results return positive. Such high-risk persons include people with HIV/AIDS or people who live in areas where TB is common.
Treatment and Cure for TB
TB is a treatable disease and one that also has a vaccine. Though seldomly used in the US, BCG vaccine is given to prevent human TB with studies showing that the efficacy of the vaccine can last for 15 years in the body after injection (Kaufmann, Weiner & von Reyn, 2017). Treatment of active pulmonary TB is done using multi-drug therapy (usually four different types of drugs), where the administration will be done and monitored to see which drug works. The drug therapy usually lasts six to nine months, where completion of the therapy is considered as crucial, given the ability of the disease to resist antibiotics (Goutelle & Maire, 2017). Failure to adhere to the drug therapy as stipulated, the healthcare provider may be necessitated to be put the patient in observed therapy where they will personally monitor the administration of the drug to the patient. Some of the common drugs used in treating TB include ethambutol, Isoniazid, Pyrazinamide, and rifampin.
Is TB a Reportable Disease?
Reportable diseases can be termed as those diseases which are listed and stipulated by law to be reported to the relevant government healthcare agency failure to which legal actions can be taken. Many countries around the world consider TB as reportable. In the US, any suspected or confirmed TB cases are supposed to be reported no more than one official working day after the identification to the TB control station. This should be done irrespective of whether the test results are out or not. Reporting should also be done when a patient has been placed under the multi-drug therapy for either active pulmonary or extra-pulmonary TB.
Social Determinants of TB in the US
Social determinants of health are factors that make a particular group more susceptible to disease than others. In most cases, they are determined by socioeconomic factors. In the US context, various social determinants make TB more susceptible to certain population groups as indicated by Noppert et al. (2018). One of the factors is racial/ethnic features. According to Noppert et al/. (2018) Blacks are at a higher risk than any other population group. The nativity status also has a role to play where the same research indicated that non-native born Americans and other migrants are at a higher risk (15% more likelihood) of getting TB than native-born Americans. This has been majorly attributed to the socio-economic status of the native countries among other factors prevalent in those countries.
Income level or the socio-economic status of individuals also have a great correlation to the likelihood of getting TB (Noppert et al., 2018). People from a low SES are highly likely to delay receiving treatment, thus, exposing others to the risk of contracting the disease. Likewise, SES determines the environment where one lives in which is also a factor linked to the increased likelihood of getting TB. Affordability of healthcare services including proper nutrition for persons having TB also makes it an issue in reducing the high prevalence of the disease among people of low SES.
Another factor is nutrition, whereby, people who have limited access to proper nutrition are at a higher risk of getting TB. Malnutrition by itself does not cause TB, whose main cause is the mycobacterium tuberculosis bacteria. However, malnourished persons have a lower immunity making them more predisposed to getting TB.
Education is also another social determinant of TB. For people with low educational status, knowledge of preventive measures and prompt treatment of the disease is limited. Thus, the result is increased exposure to the disease as compared to people with higher educational status, with equipped knowledge on the disease (Noppert et al., 2018).
As earlier alluded, the physical environment is also a major social determinant of TB. With exposure to polluted environments, the likelihood of contracting TB also increases. The inherent lifestyle behaviors are also a determinant, whereby, in areas where people smoke, share their cigarettes or engage in similar risky behaviors, there is an increased chance of getting the disease. These are some of the listed factors that have major contributions to an increased likelihood of persons getting TB
Epidemiologic Triangle of TB
Epidemiologic triangle is a useful tool in identifying the transmission of a disease, from which effective and efficient methods to prevent further transmission of the disease can be established. In an epidemiologic triad, there are three factors to consider, host factors, agent and environment factors.
For TB the host factors relate to organisms susceptible to spreading the disease. The SEIR model is usually used to describe the different categories of hosts or likely hosts for TB infection. S in the model stands for susceptible persons who are at risk of getting the disease. They persons belong to the categories described in the earlier sections of this paper. E stands for persons who are exposed but not infectious. For example, people living with infected persons or persons with latent TB. I stand for infected persons who are infectious. The R stands for persons receiving treatment or under quarantine due to the disease, including patients with latent TB under treatment (Brauer, Castillo-Chavez & Feng, 2019). Some of the host factors that increase the susceptibility of the disease include poor nutrition, lifestyle behaviors like smoking, failure to adhere to the prescribed drug therapy, poor hygiene methods, for example when sneezing and coughing, low immunity, for example, for people with HIV/AIDS, to list a few.
The agent factors are factors relating to the disease-causing organism. For TB the main causative agent is Mycobacterium Tuberculosis (Khan, 2017). Thus, managing the bacterium through vaccinations or using a prescribed drug therapy will go a long in reducing the transmission of the disease. The infectious agent is highly resistant to antibiotics and strict adherence to the treatment regimen is extremely crucial in dealing with the agent.
The environmental factors are external factors that affect the rate of spread of TB. Some of them include an unclean physical environment, poor ventilation, crowding, to list a few. Dealing with environmental factors by encouraging proper hygiene and good environmental management practices can assist in preventing the spread of the infection (Khan, 2017). The disease is airborne, therefore, ensuring good ventilation and reducing congestion and crowding in a small enclosure can also assist in preventing the transmission of the disease.
From the listed factors, emphasis on the preventive measures including seeking prompt treatment in identified cases, maintaining proper hygiene and ideal environment management, eating proper nutrition, avoiding unhealthy behaviors such as smoking, are some of the considerations that the general population can take to prevent the transmission of the disease.
Role of Community Health Nurse in Combating TB
Community health providers play an essential role in creating awareness on TB. Awareness creation is considered a vital tool in dealing with the spread of the infection. A community health nurse is also supposed to be at the forefront in ensuring that patients receive and adhere to their prescribed treatment regimens to prevent the development and spread of drug-resistant TB.
In terms of data collection and analysis, a community health nurse is in the best position of identifying, reporting and recording the number of TB cases experienced within his community. Using this information, they can assess whether the efforts they have put in place are effective in preventing TB infections. The community health providers are also supposed to asses the data on the prevalence of the disease with regards to specific population groups (Sismulyanto et al. 2019). This data is useful n coming up with targeted interventions that can be used to cushion high-risk groups against infection from the disease, including but not limited to the use of vaccines.
Other than creating targeted interventions based on collected demographic data, data on the prevalence of TB within a given community can be useful for planning purposes, especially by government institutions. For example, acquisition and distribution of drugs in high-risk populations. Analysis of any observable changes in prevalence demographics is also important, especially in understanding the cause of the change and the implications of the change in the healthcare delivery system. All this is made possible through the roles of community nurses in data collection and reporting.
National Agency Responsible for Combating TB
National Tuberculosis Controllers Association (NTCA) is a non-profit organization that was created in 1995 under the guidance of the CDC Division of Tuberculosis Elimination (DTBE). The organ has since grown to 400 members from different interest groups including nurses. The association in conjunction with other organs, governmental and non-governmental have been working to eliminate TB in the US through concerted efforts of state, local, and territorial governments. They do so by carrying out community sensitization and prevention programs. The association, together with DTBE also publishes guidelines on how to deal with various forms of TB (Sterling et al., 2020). The association also facilitates various national TB control conventions where experts come to share their approach and progress in controlling the disease.
Global Implication of TB
Globally, TB takes a substantial toll on healthcare expenditure set aside by countries (Wingfield et al., 2016). The high prevalence of the disease in third world countries makes it a major contributor to slowed economic prosperity. The disease also affects the efforts put in place to reduce the number of deaths associated with HIV/AIDS. In some developing nations in the sub-Saharan regions, the cost of treatment of TB has been absorbed by governments to improve uptake of TB treatment, reduce its transmission and development of drug-resistant TB. Free screening of the disease has also proved helpful in efforts put in place to combat the disease.
TB is found in every country around the world thus, it is not endemic in a particular area. However, more new cases are reported in the southeastern part of Asia than any other part of the world, accounting for more than 44% of new cases reported, according to the World Health Organization.
Conclusion
TB is a disease that is preventable and treatable is early diagnostic measures are put in place. It is one of the diseases that require a collective effort from both community healthcare providers and members of the community to prevent its spread. It is very crucial for community nurses to emphasize on the importance of adhering to treatment therapy by patients to avoid the spread of drug-resistant TB. Having sufficient reliable demographic information is also considered vital in focusing resources and efforts in dealing with TB.
References
Brauer, F., Castillo-Chavez, C., & Feng, Z. (2019). Models for Tuberculosis. In Mathematical Models in Epidemiology (pp. 249-272). Springer, New York, NY.
Cudahy, P., & Shenoi, S. V. (2016). Diagnostics for pulmonary tuberculosis. Postgraduate medical journal, 92(1086), 187-193. http://dx.doi.org/10.1136/postgradmedj-2015-133278
Goutelle, S., & Maire, P. (2017). Individualizing Tuberculosis Therapy. In Individualized Drug Therapy for Patients (pp. 239-254). Academic Press. https://doi.org/10.1016/B978-0-12-803348-7.00015-0
Kaufmann, S. H., Weiner, J., & von Reyn, C. F. (2017). Novel approaches to tuberculosis vaccine development. International Journal of Infectious Diseases, 56, 263-267. https://doi.org/10.1016/j.ijid.2016.10.018
Khan, A. H. (2017). Tuberculosis control in Sindh, Pakistan: Critical analysis of its implementation. Journal of infection and public health, 10(1), 1-7. https://doi.org/10.1016/j.jiph.2016.02.007
MacNeil, A., Glaziou, P., Sismanidis, C., Maloney, S., & Floyd, K. (2019). Global epidemiology of tuberculosis and progress toward achieving global targets—2017. Morbidity and Mortality Weekly Report, 68(11), 263. http://dx.doi.org/10.15585/mmwr.mm6811a3
Noppert, G. A., Malosh, R. E., Moran, E. B., Ahuja, S. D., & Zelner, J. (2018). Contemporary Social Disparities in TB Infection and Disease in the USA: a Review. Current epidemiology reports, 5(4), 442–449. https://doi.org/10.1007/s40471-018-0171-y
Sismulyanto, N., Efendi, F., Putra, M. M., & Pratama, A. A. (2019). Model to predict duty of community nurses in promotive and preventive care. International Journal of Public Health, 8(1), 26-30. DOI: 10.11591/ijphs.v8i1.13461
Sterling, T. R., Njie, G., Zenner, D., Cohn, D. L., Reves, R., Ahmed, A., … & LoBue, P. (2020). Guidelines for the treatment of latent tuberculosis infection: recommendations from the national tuberculosis controller’s association and CDC, 2020. American Journal of Transplantation, 20(4), 1196-1206. https://doi.org/10.1111/ajt.15841
World Health Organization. (2020). Fact sheet on tuberculosis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tuberculosis
Wingfield, T., Tovar, M. A., Huff, D., Boccia, D., Montoya, R., Ramos, E., Lewis, J. J., Gilman, R. H., & Evans, C. A. (2016). The economic effects of supporting tuberculosis-affected households in Peru. The European respiratory journal, 48(5), 1396–1410. https://doi.org/10.1183/13993003.00066-2016.
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